Patients become symptomatic only when there is tissue loss (= destruction of the hormone-producing cells of the adrenal cortex, NNR) of more than 90% of both NNR.
The following symptoms and complaints may indicate Addison’s disease:
Neonates/infants
- Hypoglycemia (low blood sugar).
- Dehydration (lack of fluid)
- Cholestasis (bile stasis)
- Failure to thrive
- Recurrent vomiting
- Salt wasting crisis (salt starvation) with hyponatremia (sodium deficiency) and hyperkalemia (potassium excess); may lead to shock
Children/adolescents/adults
- Adynamia (as the disease progresses).
- Anorexia (loss of appetite)
- Pronounced fatigue
- Dehydration (lack of fluids)
- Diarrhea (diarrhea)
- Abdominal pain (abdominal pain)
- Vomiting
- Weight loss
- Skin
- Bronze-colored skin (hyperpigmentation; “brown Addison’s”)* ; almost always generalized; more pronounced in skin folds, palmae manus (palms), nipples, genitals, linea alba (Latin for “white line”; vertical suture of connective tissue in the middle of the abdomen), and scars; pathognomonic (proving the disease) are hyperpigmentation in the oral cavity
- Vitiligo (white spot disease; about 12%).
- Hyperkalemia* (excess potassium).
- Hypoglycemia (hypoglycemia)
- Hyponatremia (sodium deficiency)
- Hypotension (too low blood pressure)
- Decline in performance or performance deficit
- Metabolic acidosis* (hyperacidity)
- Constipation (constipation)
- Salt loss
- Shock
- Weakness
- Syncope (momentary loss of consciousness)
- Delayed pubertal development
- Growth arrest
* Only primary (not secondary NNR insufficiency) results in these symptoms. Typical findings of mineralocorticoid deficiency include hyponatremia, hyperkalemia, and metabolic acidosis.
Addisonian crisis (acute NNR insufficiency)
The following symptoms and complaints may indicate an Addisonian crisis:
- Fever
- Hypotension to shock
- Deterioration of the general condition
- Nausea (nausea)/vomiting and diarrhea (diarrhea) → dehydration (lack of fluids).
- Hyponatremia
- Abdominal discomfort (pseudoperitonitis/sham peritonitis).
- Risk of preterminal renal failure.
- Restlessness, confusion and apathy.
